Amniotic-Umbilical-to-Cerebral Ratio – A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term

Abstract

Purpose Introduction of a novel ratio – the amniotic-umbilical-to-cerebral ratio (AUCR) – to predict adverse perinatal outcome in SGA fetuses at term and comparison of its predictive accuracy with established parameters.

Materials and Methods This retrospective cohort study included 165 singleton pregnancies with SGA fetuses (birth weight < 10^th percentile) at term. Cases with planned vaginal delivery and documented pulsatility indices (PI) of the umbilical artery (UA), middle cerebral artery (MCA), and single deepest pocket (SDP) were included. CPR was calculated as the ratio between MCA PI and UA PI, UCR as the ratio between UA PI and MCA PI. AUCR was defined as follows: SDP/(UA PI/MCA PI). Adverse perinatal outcomes were defined as operative intervention (OI), OI due to fetal distress, admission to the neonatal intensive care unit (NICU), and composite adverse perinatal outcome (CAPO). Associations between Doppler parameters and these outcomes were estimated using regression analyses.

Results OI was statistically significantly associated with UCR, SDP, and AUCR, whereas no association was observed for UA PI, MCA PI, and CPR. Fetuses requiring OI due to fetal distress revealed a significantly higher UA PI and UCR as well as a lower MCA PI, CPR, and AUCR. With regard to NICU admission and CAPO, a significantly higher UA PI and lower CPR were found. Furthermore, a significant association was shown for SDP, UCR, and AUCR. AUCR achieved the best area under the curve for all outcome parameters.

Conclusion AUCR leads to an improvement in the prediction of unfavorable outcome in SGA fetuses at term. Furthermore, results of our study show that UCR might be superior to CPR.

Zusammenfassung

Ziel Beschreibung einer neuen Ratio – der Amniotic-Umbilical-to-Cerebral-Ratio (AUCR) – zur Prädiktion eines ungünstigen Geburtsoutcomes bei SGA-Föten am Geburtstermin und Vergleich mit etablierten Parametern.

Material und Methoden Retrospektive Kohortenstudie mit 165 SGA-Föten (Geburtsgewicht < 10. Perzentile) am Geburtstermin. Fälle mit geplanter Spontangeburt und dokumentierten Pulsatilitätsindizes (PI) der A. umbilicalis (UA), A. cerebri media (MCA) und tiefstem Fruchtwasserdepot (single deepest pocket, SDP) wurden eingeschlossen. Die CPR wurde als Quotient aus MCA und UAPI berechnet, die UCR umgekehrt. Die AUCR wurde wie folgt definiert: AUCR = SDP/(UA PI/MCA PI). Die Assoziationen zwischen Dopplerparametern, operativer Intervention (OI), OI bei pathologischem CTG, Verlegung auf die neonatologische Intensivstation (NICU) und kombiniertem adversem Outcome (CAPO) wurden mittels Regressionsanalyse ausgewertet.

Ergebnisse Eine OI war signifikant mit der UCR, dem SDP und der AUCR assoziiert, wohingegen kein Zusammenhang für UA PI, MCA PI und CPR gefunden wurde. Föten mit OI bei pathologischem CTG hatten signifikant höhere UA PI, niedrigere MCA PI und niedrigere CPR. Weiterhin war die UCR signifikant höher und die AUCR signifikant niedriger. Signifikant höhere UA PI und niedrigere CPR zeigten sich bei NICU und CAPO. Weiterhin bestand ein signifikanter Zusammenhang auch für SDP, UCR und AUCR. Die beste Area under the curve wurde bei allen Outcome-Parametern durch die AUCR erreicht.

Schlussfolgerungen Die AUCR verbessert die Prädiktion eines ungünstigen Outcomes bei SGA-Föten am Termin. Außerdem zeigt unsere Studie, dass die UCR der CPR überlegen zu sein scheint.

Key words

SDP - amniotic fluid - CPR - UCR - AUCR

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